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A discussion of planning practices during a management development class was teetering on the brink of becoming a gripe session when one manager exclaimed in frustration, "How can I possibly set goals for my department when there's never enough staff, there are chronic shortages of the most needed skills, and there's never enough budget to carry out our plans? What am I supposed to do-keep planning anyway?"


As heads nodded and grumbles of assent rippled about the room, a manager of many years' experience said, "Maybe you should set goals with your department, not for your department."


Another person added, "Of course you're supposed to keep planning anyway. If you think things are a mess with a little planning, you should try to get along with no planning at all!"


Unfortunately, too many managers frequently find themselves getting along with no planning at all. This age-old, go-with-the-flow approach to management has been with us since time immemorial, giving rise to labels like management by crisis, fire-fighting management, and such. The manager who is always in a reactive mode, always shifting his or her attention to the trouble spot of the moment, is "in charge" of little or nothing.


The manager has a choice. He or she can consciously choose to control the job or can, by default, choose to be controlled by the job.


It may frequently seem as though those in that first layer of management, the folks between middle management and the people who do the hands-on work, are in a position of exercising little if any control. It is all too easy to succumb to the pressures coming from both above and below and, at any given moment, rush toward the hottest burning fire or the most loudly squeaking wheel. That is, in the absence of a conscious effort to the contrary, it is all too easy to allow ourselves to be controlled by our jobs.


The way to gain control of the department manager's job is found in small modest changes in work habits and practices. It is found not in ponderous planning calendars and formal time-management routines; rather, it is found in the manager's determination to focus on doing right things right the first time, and it is found in the manager's determination to always differentiate between what is immediately important and what is not.


An old-fashioned approach to job planning that has been around for many years remains highly appropriate. That is:


* At the end of today, jot down the 3 or 4 most important tasks you have facing you.


* Put these tasks in strict priority order.


* Tomorrow when you begin work, start on the highest priority task and stay with it until it is finished. If you are pulled off for reasons beyond your control (for example, your boss's demands or a true crisis), as soon as the distracting force goes away, get back on your highest priority task.


* Only when your top priority task is totally under control should you go on to the next most important task.


* At the end of every day, make a new list of the most important tasks facing you and establish a new priority order.



With a modest approach to personal planning such as this, you will not revolutionize management. You may not even feel as though you are making much of a dent in the total pile of work facing you. You can, however, be assured of one extremely important fact: working this way, you will know that at any given time, you are addressing the most important task in the pile. This can represent a giant step toward taking control of your job.


This issue of The Health Care Manager (24:1) offers the following articles for the reader's consideration.


* "Tools for Novice Health Care Clinical Administrators" provides practical advice to successful technical experts who have been promoted to clinical management positions having had little or no training or experience in management.


* "Social Marketing as a Tool to Improve Behavioral Health Services for Underserved Populations in Transition Countries" examines the justification for utilizing the concepts and tools of social marketing to bring about proactive behavior modification among segments of underserved populations.


* "Hospital Restructuring Stressors, Support, and Nursing Staff Perceptions of Unit Functioning" reports on a growing body of research findings identifying dimensions of change related to hospital restructuring and downsizing that serve as sources of stress for nursing staff.


* Case in Health Care Management: "The Holiday Switch" asks the manager to consider the problems created by an employee who "willingly" switches to cover a holiday and then turns the situation to her advantage and leaves the unit short-handed.


* "Hospital Nurses' Intentions to Remain: Exploring a Northern Context" reports on a study undertaken to determine working nurses' intentions to remain employed in their present capacities in a number of northern hospitals in Western Canada.


* "Passion in Today's Healthcare Leaders" suggests that passion for health care work is an essential element in determining leaders who have been promoted and retained based on their analytical and creativity skills.


* "Using a Multipronged Approach to Implement Organizational Performance Improvements" suggests that the chances of success of efforts to improve organizational performance can be improved by an approach that combines a systems implementation process with sensitivity to the human side of change.


* "Conflict Management in Public University Hospitals in Turkey: A Pilot Study" reports on a study designed to measure sources of conflict in the workplace at Gazi University Hospital in Turkey, illustrating, among other things, that many of the problems of those who manage in health care are similar regardless of country.


* "Incorporating Ethics Into Your Comprehensive Organizational Plan" outlines a comprehensive plan encompassing 6 individual plans addressing competition, facilities, finances, human resources, information management, and marketing, including an overlay of ethical considerations for each.


* "The Manager and Oral Presentations: From Conference Room to Convention Hall" addresses public speaking as an essential skill for health care managers who wish to advance in their careers and describes how any working manager can become an effective speaker.


* A Manager Asks: "Working and Coping With Physicians" addresses some concerns commonly experienced when difficulties arise between support staff and physicians in a sometimes-chaotic office environment.